Netherlands Nature and prevalence of elder abuse in the

Nature and prevalence of

elder abuse in the

- SUMMARY

With the cooperation of Anne Werter, Remy Boerhoop en Mats Gorter

Avans Hogeschool: Janine Janssen

With the cooperation of the staff department of the Lectorate of Safety in dependent relationships and 24 interviewers

Leyden Academy on Vitality and Ageing: Jolanda Lindenberg

Amsterdam, 25th _{May 2018}

© 2018; Wetenschappelijk Onderzoek- en Documentatiecentrum.

Copyright reserved. No part of this report may be reproduced and / or made public by means of printing, photocopying, microfilm, digital processing or otherwise, without prior written permission from the WODC.

Nature and prevalence of elder

abuse in the Netherlands

1

Background and structure of the study

There is little current knowledge about the nature and prevalence of elder abuse in the Netherlands. The assumption is that with the increased ageing of the population, the elderly continuing to live at home longer, and the growing emphasis on self-sufficiency, the problem can become exacerbated in the future if we don’t have sufficient control of prevention and intervention. Against this background, and at the request of the Ministry of Health, Welfare and Sport (VWS), the Scientific Research and Documenta-tion Centre (WODC) has commissioned Regioplan to conduct a study on the nature and scope of elder abuse. Regioplan has carried out the study in 2017 and 2018 in collaboration with Avans University of Applied Sciences (Lectorate of Safety in dependent relationships) and Leyden Academy on Vitality and Ageing.

The study took place in Rotterdam, Tilburg and Boxtel. Several frameworks were set in advance in order to define the research: (1) the elderly who participate in the study are 65 years old and older, and (2) the elderly who participate in the study live at home. A distinction is made in this study among five forms of elder abuse, specifically neglect, psychological abuse including violation of rights, physical abuse, financial disadvantage and sexual abuse.

To be able to form as good a picture as possible of the prevalence, a combination of various research methods has been applied, specifically (1) a large number of face-to-face interviews with a representa-tive group of those aged 65 and older in three municipalities of varied size, (2) an informant study where signals of elder abuse were registered by several professional groups in three municipalities, (3) registra-tions of the Veilig Thuis (‘Safe Home’) organisation (notificaregistra-tions and recommendaregistra-tions in three munici-palities) as a supplementary source, and (4) a literature study as a frame of reference for the interpreta-tion of the research results.

Interview study

A random sample of 8896 of those persons aged 65+ were invited by letter to join the study. More than have of those invited (52.7%) declined after receiving the letter. The remaining addresses were visited by interviewers. From these home visits (N = 4199), a total of 1015 interviews were conducted (24.2% of all home visits and 11.4% of the addressed individuals). The analyses have been conducted from 1002 usable interviews. Of the response group, 47.4% are female and 52.6% are male. The average age is 74.8 years, with ages varying from 65 to 100 years. Respondents are relatively highly educated. Approximate-ly 90% have a Dutch background. Although the response group is not entireApproximate-ly representative for the Dutch 65+ population, the results appeared to be virtually unchanged after correction on the basis of the distribution according to gender, age and education.

The interview study shows a 5.5% prevalence of elder abuse since the age of 65 and 2.0% in the past year. This means that 1 in 20 elderly have ever dealt with elder abuse and that annually 1 in 50 elderly will become a victim of elder abuse. According to the applied definition of elder abuse, a minimal fre-quency of psychological abuse and neglect is required to be considered elder abuse. For this reason, a cut-off limit of ten times for psychological abuse and neglect has been used in the calculation of both figures.

The most reported form of elder abuse is financial disadvantage, followed by psychological and physical abuse. Neglect (and sexual abuse) were not or scarcely reported. In 1 in 10 victims, multiple forms of elder abuse occurred. For the largest number of the victims, elder abuse is repeated and sometimes occurs systematically. Our findings closely follow the findings of the Irish study of Naughton et al. (2010) which shows a prevalence of 4.0% since the age of 65 and 2.2% in the past year. This study has a very comparable study design with face-to-face interviews with those aged 65+ who live at home with sup-port from the CTS and the same cut-off limit for psychological abuse and neglect.

2 Approximately half of the victims in this study are female and half male. There is a great variety of ages. Almost all victims have a Dutch background (98.2%). The results imply that victims are more vulnerable than those aged 65+ who are not a victim of elder abuse, and specifically in the following areas: a more vulnerable financial situation (payments in arrears), more health complaints, less social participation, more loneliness, more psychological complaints and more stressful events. The situation in which someone has previously been a victim of abuse also occurs more often. Based on this study, a causal relationship cannot be determined.

Most victims discuss the events with others, usually with immediate family members such as a son, daughter and/or partner. When victims discuss the abuse with professionals, this is predominantly with the police or the general practitioner. As far as is known, approximately three in ten victims have filed a report with Veilig Thuis and/or the police. In response to the discussion of abuse, approximately half of all victims have received some form of assistance.

The majority of the victims describe having consequences in the emotional sphere (distress, suffering from stress, fear, anger and the like), in the relational sphere (loss of trust, broken contact), and in social relationships/surroundings (fewer contacts, loneliness, feeling less secure in their living environment). Of the reported perpetrators, almost six in ten are male. The perpetrators are often a friend or ac-quaintance, a neighbour, a brother or sister, or a son or daughter of the victim. As far as is known, some of the perpetrators have financial problems, addiction and/or emotional problems, or have been in contact with the police or the judiciary. In addition, some of the perpetrators have a very limited social circle.

Informant study

During the course of the informant study (four months), 44 unique suspicions of elder abuse were regis-tered by 51 informants from 16 professional groups, such as home care, nursing staff, volunteer work and notaries. The suspicions most often concerned psychological abuse, followed by physical abuse and financial disadvantage. Violation of rights, neglect and one case of sexual abuse were also registered. Often, it concerned a combination of two forms of elder abuse. Most signals which were registered came from professionals who work in non-hospital care. In particular, elder abuse was reported in a context of derailed informal care (powerlessness, inability, overtaxing by the perpetrator).

The victims who were seen are predominantly female, and almost half of the victims are of a high age (80 years or older). Approximately 10% have a non-Dutch background. Half of the victims are married and live with a partner, while a great number of the other victims live alone. It seems that a more vul-nerable group of victims has been identified by the informants than with the interview study. Inform-ants report various vulnerabilities: almost half of the victims have memory problems and one in five is dealing with stress complaints. According to the informants, three in four victims are no longer self-sufficient, or only in a limited manner. There is a suspicion that approximately half of the victims suffer from loneliness and a lack of a social network, and informants suspected financial problems in more than a quarter of the victims.

3

Conclusions and implications

In conclusion, we can state that 1 in 20 of those aged 65+ who live at home have ever experienced elder abuse, and 1 in 50 experiences elder abuse on an annual basis. This corresponds significantly with the re-sults of previous, comparably designed research abroad. What is important to emphasise here is that in our interview study, elder abuse has been measured in a manner that is as valid as possible (specifically, elder abuse in a relational context; it is partly clear that it has taken place within a dependent relationship, and – in relation to psychological abuse and neglect – it concerns more than occasional incidents), and that re-ports reflect a group that is as representative as possible of those aged 65+ who live at home. There was, however, a significant level of drop-outs. The intensity of the interview method used has probably played a role here. It is possible that dropping out has taken place proportionally more among the vulnerable elderly, as a result of which the prevalence of elder abuse can be underestimated. A much higher percentage (17% of those aged 65+) reported knowing someone else aged 65 and older who is or has been a victim of elder abuse. Therefore, the prevalence results must be considered to be the lower limit.

The study shows that elder abuse appears in many forms and degrees of severity and can have various consequences. Victims of elder abuse can by characterised by a number of vulnerabilities, such as those related to deteriorating health and psychological functioning, limited self-sufficiency and social network, or financial difficulties. These vulnerabilities also appear to hold true for the perpetrators. For the prevention and recognition of and the approach to elder abuse, these vulnerabilities can function as a signal to conduct further research into the specific situation of the relevant elderly person and his or her social network. The findings of this study offer several focus points or perspectives for practical application:

- provided there is sufficient attention, time and knowledge of the issue, institutions are able to actively signal elder abuse;

- not only professionals but also the elderly themselves and their social networks are and remain im-portant target groups when it comes to education with respect to the subject matter and opportunities for help;